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Providing Patients Easy Access to Physician Notes in Their EMRs

Posted Jul 15 2009 8:10pm

I have been intrigued over past years by discussions concerning patients' rights to view their own medical records. An argument is frequently made by physicians that much of content in a hospital or office EMR is unintelligible, confusing, or unsuitable for patients to view. This may be true. However, many hospitals, on request, will allow patients to view their own medical records while in the hospital. Additionally, patients post-discharge can also request a copy of their chart, generally to provide to other physicians. A recent article takes up this same topic in the context of a project at Beth Israel Deaconess Medical Center allowing patients access to their physician notes in the EMR (see: Patients to get a look at physicians' notes ). Below is an excerpt from it with boldface emphasis mine:

One doctor wrote that a patient was acting paranoid. Another typed that she had ordered tests to make sure a patient didn’t have cancer. Such notes, written in a patient’s medical records after an appointment, can be candid and blunt - at times more so than doctors are to patients face-to-face. Amid the national push to computerize medical records and make them more open to patients, one of the most intense areas of debate is whether patients should be allowed to see their doctors’ notes online....B ut the notes usually aren’t readily available to patients because hospitals and doctors’ groups fear that they will misunderstand medical jargon, take offense at a blunt observation, or worry unnecessarily about a precautionary test.Beth Israel Deaconess Medical Center, however, is about to begin a project called “ open notes ’’ in which about 100 doctors at the hospital and two other sites will allow 25,000 to 35,000 patients to read their physicians’ notes for a year as part of their online medical record. Researchers hope to learn whether the notes prove more useful than objectionable. They hypothesize that access to doctors’ notes will improve care partly because patients will become more knowledgeable about their treatment and about their doctors’ instructions.... [Developers of the project] are developing detailed surveys to give patients, including whether they read the notes and found them useful, and whether they discovered errors.....The ultimate measure of success will be whether doctors and patients want to keep sharing notes at the end of the study.... In Boston, Partners HealthCare, which includes Massachusetts General and Brigham and Women’s hospitals, is discussing making “summary notes’’ available to patients but not the full note....Partners is experimenting with providing patients with lab results online as soon as they are available and before the doctor has a chance to review them. The results “so far suggest that the sky does not fall in,’’....

The Open Notes Project will enable all patients enrolled in the study to view the physician notes entered into their medical record. I think that this is a very good idea. It's a good idea because it will cause physicians to be more careful about what they enter into the medical record, avoiding hearsay and off-the-cuff comments. Access to physician notes also provides the opportunity for patients to more actively engage in their own care processes. In fact, I suspect that ad lib narrative notes may have largely outlived their usefulness, to be replaced mainly by structured notes selected from pull-down menus available within the EMR. Such documentation may not be as colorful as some of the narrative comments of past years but will provide overall clearer documentation about the status of a patient. I am obviously very enthusiastic about the Partners HealthCare plan to provide on-line access to patients of their own lab test results (see: Physician Failure to Inform Patients of Abnormal Lab Tests All Too Common).

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